DEVELOPMENT OF ADENOCARCINOMA AFTER RADIOFREQUENCY ABLATION OF BARRETT’S ESOPHAGUS ASSOCIATED TO FUNDOPLICATION AND SUPPRESSION-DUODENAL DIVERSION PROCEDURE: A LESSON TO BE LEARNED

ABSTRACT Despite endoscopic eradication therapy being an effective and durable treatment for Barrett’s esophagus-related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require ongoing routine examinations. Failure of radiofrequency ablation and argon plasma coagulation is reported in 10–20% of cases.


A QUEDA DA PRESSÃO APÓS DESVASCULARIZAÇÃO ESOFAGOGÁSTRICA ESPLENECTOMIA INFLUENCIA A VARIAÇÃO DO CALIBRE DAS VARIZES E TAXAS DE RESSANGRAMENTO NA ESQUISTOSSOMOSE NO SEGUIMENTO LONGO PRAZO?
Does the drop in portal pressure esophagogastric devascularization and splenectomy variation of variceal and the rebleeding rates in schistosomiasis in late follow-up?
Walter de Biase SILVA-NETO 1 , Claudemiro QUIRESE 1 , Eduardo Guimarães Horneaux de MOURA 2 , Fabricio Ferreira COELHO 3 , Paulo HERMAN 3 ABSTRACT -Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy.However, studies have shown varices recurrence especially after long-term follow-up.Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS.Methods: Thirty-six patients submitted to EGDS portal pressure drop, less than 30%, and compared with the esophageal varices and the rate of bleeding recurrence.Results late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy.

Conclusion variceal calibers when comparing pre-operative and early or late post-operative
The comparison between the portal pressure drop and the rebleeding rates was also not

Mensagem central
A desconexão ázigo-portal e esplenectomia apresenta importante impacto na diminuição precoce do calibre das varizes esofágicas na esquistossomose; entretanto, parece que a associação com a terapia endoscópica é a maior responsável pelo controle da recidiva hemorrágica.R ecently, it was published the paper "Suppressionduodenal diversion procedure for long-segment Barrett´s esophagus: early and long-term outcome" 1 .During the postoperative follow-up, eradication of dysplasia was obtained, as shown in Table 5 of this paper.However, in one patient initially presenting low grade dysplasia, after 5 years of follow-up, the presence of adenocarcinoma at distal esophagus was confirmed histologically, probably remaining buried cells (Table 1) 1 .The complete assessment included computed tomography (CT) scan, positron emission tomography (PET) scan, and endo-sonography, affirming a T1b esophageal adenocarcinoma.The definitive treatment indicated for this patient was esophagectomy with colon interposition.
This finding encourages a very close follow-up because the risk of reappearance of dysplasia remains and, therefore, it is important to keep attention to this eventual complication that unfortunately, occurred to our patient.
Despite the fact that endoscopic eradication therapy is an effective and durable treatment for Barrett's esophagus (BE) related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require continuous examinations.Failure of radiofrequency ablation (RFA) and argon plasma coagulation (APC) is reported in 10-20% of cases 1,3 .
For other authors, BE recurrence after ablation can occur in almost one-third of patients with baseline dysplastic disease -mostly during the first year after complete eradication of intestinal metaplasia (CEIM) 4,7,9 .
Titi et al. reported the development of subsquamous neoplasia in three patients who were treated with RFA for BE (two developed adenocarcinoma and one developed high-grade dysplasia) 10 .Therefore, patients with BE treated with RFA have a risk of developing subsquamous high-grade dysplasia and adenocarcinoma after successful RFA of BE.In other publications, ABCD Arq Bras Cir Dig 2023;36:e1786 the development of subsquamous high-grade dysplasia and adenocarcinoma after successful RFA of BE has been also reported.A better prognosis was obtained after combining ablation and proton pump inhibitors 5,11 .
Our idea went even further ahead performing ablation combined with acid suppression-bile diversion surgical procedure.But, a very disappointing experience occurred with this patient previously mentioned.For this reason, follow-up endoscopies every 6 months are a valid alternative, and it is the way to detect early recurrence or progression to dysplastic lesions 6,8 .This is a great lesson to keep in mind!

Table 1 -
1istologic results after treatment with argon plasma coagulation or radiofrequency ablation in patients with intestinal metaplasia alone or with dysplasia.The results were observed during follow-up1.Eradication with regression to carditis; † Treated with repeated APC; ‡ Submitted to endoscopic submucosal dissection.§ Submitted to esophageal resection.APC: argon plasma coagulation; RFA: radiofrequency ablation; LGD: low-grade dysplasia; IM: intestinal metaplasia; HGD: high-grade dysplasia.